Articles: cations.
-
Facet or zygapophysial joint blocks are used extensively in the evaluation of chronic spinal pain. However, there is a continuing debate about the value and validity of facet joint blocks in the diagnosis of chronic spinal pain. The value of diagnostic facet joint injections may have been overlooked in the medical literature. ⋯ The diagnostic accuracy of controlled local anesthetic facet joint blocks is high in the diagnosis of chronic spinal pain.
-
Radiofrequency heat lesioning has been advocated to prolong the duration of therapeutic effect of lumbar sympathetic block in Complex Region Pain Syndrome (CRPS) of the lower extremity. Prior to radiofrequency lesioning of the lumbar sympathetic trunk, sensory and motor stimulation may be used to verify that the active needle tip is not adjacent to a spinal nerve to avoid unwanted neural injury. However, the value of sensory stimulation to aid in precise needle positioning at the desired target remains controversial. ⋯ Motor stimulation did not occur up to the maximum voltage tested (2.0 V at 2 Hz) Sensory stimulation of the lumbar sympathetic trunk may be used to aid in localization of the active tip of the radiofrequency needle, in preparation for lesioning. A dermatomal sensory pattern was observed, suggesting that afferent sensory fibers travel in the lumbar sympathetic trunk. The implications of this observation for understanding the mechanism of CRPS-related pain are discussed.
-
Bronchiolar pathologic lesions result from the interplay between inflammatory and mesenchymal cells following injury to bronchioles. Offending agents include viruses, bacteria, fungi, cigarette smoke, toxic inhalants, inorganic dusts, allergens, and systemic or localized autoimmune or inflammatory processes. Bronchiolar pathologic lesions also arise in the context of allograft transplantation and pathology of the large airways and in the setting of an idiopathic disorder. ⋯ After a survey of the normal histology of bronchioles, we present a pragmatic classification that reflects the spectrum of bronchiolar pathology, illustrating the intimate interdependence of clinical, radiological, and pathologic findings in assessing the significance of bronchiolar lesions. This classification is intended to be applicable to surgical pathology material that can be correlated with clinical disease syndromes. It includes asthma-associated bronchiolar changes, chronic bronchitis/emphysema-associated bronchiolar changes, cellular bronchiolitis, respiratory bronchiolitis, bronchiolitis obliterans with intraluminal polyps/ BOOP, constrictive bronchiolitis, mineral dust small airway disease, peribronchiolar fibrosis and bronchiolar metaplasia, and bronchiolocentric nodules.
-
Inflammatory and fibrotic processes can involve the small airways (i.e., respiratory and terminal bronchioles) in several connective tissue disorders (CTDs). Obliterative (constrictive) bronchiolitis (OB) as well cryptogenic organizing pneumonia (COP), previously termed bronchiolitis obliterans with organizing pneumonia (BOOP), are well-recognized, albeit rare, complications of rheumatoid arthritis and other CTDs. Bronchiectasis has also been described in patients with CTDs. ⋯ Surgical (open or thoracoscopic) lung biopsies can substantiate the diagnosis, but in some cases, the diagnosis can be affirmed less aggressively by appropriate imaging studies (e.g., HRCT) and transbronchial lung biopsies. Corticosteroids are highly efficacious for COP, but therapeutic options for OB are disappointing. Prophylactic antibiotics and good pulmonary hygiene remain the mainstay of therapy for patients with bronchiectasis.
-
Lumbar zygapophyseal joints have long been considered a source of low back pain with or without leg pain. The objective of this prospective study was to investigate the therapeutic effectiveness of lumbar zygapophyseal joint radiofrequency denervation (RFD) followed by physical therapy, for the treatment of refractory lumbar zygapophyseal joint mediated low back pain secondary to lumbar zygapophyseal joint synovitis, in baseball pitchers. Participants included twelve male baseball pitchers with a diagnosis of lumbar zygapophyseal joint synovitis mediated low back pain and a subsequent difficulty in pitching. ⋯ Ten out of 12 (83%) athletes were able to return to pitching at a level attained prior to RFD. All 12 patients, experienced statistically significant low back pain relief, with a mean pre-RFD VAS of 8.4; mean post-RFD VAS of 1.7; mean pre-RFD R-M score of 12.3; and mean post-RFD R-M score of 22.3. In conclusion, athletes, experiencing lumbar zygapophyseal joint mediated low back pain secondary to zygapophyseal joint synovitis and have failed more conservative management may benefit from radiofrequency zygapophyseal joint denervation followed by a formal rehabilitation program.